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Survivor Benefits Supervisor
Wespath Benefits and Investments
in Glenview IL

Senior Plan Document / Compliance Specialist
Professional Capital Services, LLC (PCS)
in Philadelphia PA

Senior Retirement Plan Administrator
Professional Capital Services, LLC
in Philadelphia PA

Employee Benefits Compliance Associate
Slevin & Hart, P.C.
in DC

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Webcasts, Conferences

ERISA for Non-ERISA Lawyers
September 24, 2019 WEBCAST
American Bar Association Joint Committee on Employee Benefits [JCEB]

2020 Onsite Employee Health Clinics Summit
January 23, 2020 in AZ
World Conference Forum

►See 134 Upcoming Webcasts and Conferences

►See 1529 Recorded Webcasts


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[Official Guidance]

Text of CMS Benefit Year 2018 Risk Adjustment Summary Report (PDF)

33 pages. "[F]or the 2018 benefit year: [1] Risk adjustment transfers as a percent of premiums slightly decreased compared to the 2017 benefit year.... [2] Amount of paid claims remains strongly correlated with risk adjustment transfers ... [3] Predictability between interim and final risk scores remained stable between the 2017 and 2018 benefit years ... [4] Risk scores remained similar between 2017 and 2018.... [5] Average premiums in the individual non-catastrophic risk pool increased significantly in 2018 ... [6] The high-cost risk pool helped ensure that risk adjustment transfers better reflect the average actuarial risk, while also providing protection to issuers with exceptionally high-cost enrollees."

Data available in XLSX format:

  • Appendix A: HHS Risk Adjustment Program State-Specific Data
  • Appendix B: HHS Risk Adjustment Geographic Cost Factor (GCF)
  • Appendix C: Issuer-Specific Information for Non-Merged Market Issuers
  • Appendix D: Issuer-Specific Information for Merged Market Issuers
  • Appendix E: Default Risk Adjustment Charge
  • Appendix F: Default Risk Adjustment Charge Allocation

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Joint Effort Leads to New Health Reimbursement Arrangement Guidance

"Employers offering an [Individual Coverage HRA (ICHRA)] do not need to be concerned with the MEC requirements: employees must certify that the individual health insurance they purchase meets those requirements. Employers offering an ICHRA do need to consider whether the ICHRA is affordable.... The IRS issued proposed safe harbors in Notice 2018-88 in order to provide guidelines applicable to ICHRA affordability determinations.... [E]mployers and employees are subject to [ICHRA] notice and coverage substantiation requirements. These notice requirements do not apply to other HRAs."

[Guidance Overview]

HHS Proposes Changes to Non-Discrimination Regs Under ACA Section 1557

"In addition to gender identity and termination of pregnancy, the proposed regulations also would substantially change, or in some cases entirely eliminate, provisions regarding health insurance benefit design; language access; notices, grievance procedures, and enforcement; and which entities are covered.... This issue brief summarizes and considers the implications of key proposed changes. [One table] compares current and proposed provisions of HHS's Section 1557 regulations, and [a second table] summarizes HHS's proposed changes to other regulations, separate from Section 1557."
Henry J. Kaiser Family Foundation

[Guidance Overview]

Connecticut Becomes Seventh State to Enact Paid Family Leave Law

"[The Connecticut Paid Family and Medical Leave Act (CPFML)] creates a new paid leave program ... expanding the reasons employees may take leave and the amount of leave available to employees.... [T]he CPFML appears to be fully employee-funded.... Employers must begin to collect contributions as of January 1, 2021. Employees will be able to start receiving CPFML benefits ... January 1, 2022."
Seyfarth Shaw LLP

[Guidance Overview]

Massachusetts Paid Family and Medical Leave Act: Next Steps for Employers

"[1] Ensure the updated workplace poster is hung in your Massachusetts workplaces. [2] If you sent notices to your employees prior to June 14, 2019, ensure the updated rate sheet is sent and that you are tracking that it has been sent. [3] If you have not yet sent notices, send the updated notice based on your workplace size prior to September 30, 2019, and ensure signatures are collected. [4] If you are a covered business entity under the law, ensure your Massachusetts 1099-MISC independent contractors receive a notice; they are required to sign the notice by September 30, 2019. [5] Prepare your payroll based on the updated tax percentage, and ensure that payroll taxes are ready to be remitted starting October 1, 2019."
Nixon Peabody LLP

New York City Council Considers Mandatory Paid Personal Time

"The proposal ... [would allow] covered employees to accrue one hour of personal time for every 30 hours worked, up to 80 hours of personal time per calendar year. These 80 hours would be available for employees to use for any reason and, as the Bill currently stands, would be in addition to the 40 hours of sick/safe time provided to eligible employees."
Seyfarth Shaw LLP

San Antonio Issues FAQs Regarding Paid Sick Leave Ordinance

"San Antonio has recently created a FAQ document about its ordinance.... The city's Metropolitan Health District will not be assessing penalties for violations, except in cases of retaliation, until April 1, 2020. From August 1, 2019 until April 1, 2020, the District will be focusing on educational compliance."

71 Percent of Massachusetts Employers Offered Health Plans

"In 2018 ... 71% of Massachusetts employers offered health insurance plans to their employees ... compared to 65% of employers who offered plans in 2016. It's also higher than the national rate of 57%.... [J]ust 67% of workers who were eligible for their employer's health insurance chose to enroll -- lower than the national takeup rate of 76%."

Appellate Court Raises Potential New Threat to ACA

"The U.S. Court of Appeals for the 5th Circuit, which is scheduled to begin hearing oral arguments about the constitutionality of the law on July 9, said it needed more information as to whether the House and Democratic states had standing to intervene in the lawsuit and whether their interventions were timely." [Texas v. Azar, No. 19-10011 (5th Cir. request for supplemental briefs Jun. 26, 2019)]
The Washington Post; subscription may be required

ACA Risk Adjustment Program 'Operated Smoothly' in 2018, CMS Says

"A total of 572 insurers participated in the risk-adjustment program last year, down from 654 insurers a year prior. Total transfers for the 2018 benefit year were about $10.4 billion, with half of that amount being payments CMS disbursed and the other half being charges CMS collected, since the program is required by law to be budget neutral."
HealthLeaders Media

Rebalancing High Prescription Drug Prices with Innovation Incentives

"[This post reviews] the previously published literature on the relationship between high drug prices and innovation incentives.... While high prices and innovation do not necessarily move in lockstep, it is undeniable that innovators develop new drugs in response to economic incentives.... The major barrier thus far to developing effective policy in this area is our lack of empirical evidence for how fungible price and non-price innovation drivers are and how best to deploy each to optimally address unmet medical needs. Finally, to help resolve this impasse, [the authors] propose a three-pronged approach."
Health Affairs

Benefits in General

Health Costs in Retirement: 2019 Estimates (PDF)

"A healthy 65-year-old couple retiring in 2019 is projected to spend $369,000 in today's dollars ... on healthcare over their lifetime, and expenses at age 85 are estimated to be 250% higher than at age 65.... A healthy 67-year-old retired couple is projected to spend 39% of their pre-tax Social Security benefit on healthcare in 2019.... A healthy 45-year-old couple who retires at age 65 is projected to pay $532,000 in 2019 dollars, and $1.4 million over their retirement years, for retiree healthcare.... The estimated 2019 annual premium plus out-of-pocket cost for a healthy 65-year-old is $5,000."

Help Employees Choose the Right Benefits to Manage Health Care Costs in Retirement

"[1] Encourage employees to look ahead, not just live in the moment ... [2] From saving to spending: The lifetime benefits of HSAs ... [3] Explain how voluntary benefits fill the 'coverage gap' at every life stage ... [4] The power is in the combination."

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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